Segmental volvulus of small intestine: report of a case with an innovative method of surgery

Normal embryonic intestinal rotations were first described by Mall in 1898 [1]. In 1923, Dott, published the article about abnormalities of rotation and fixation with their surgical aspects [2]. Classic Ladd's procedure as an academic operative technique to treat midgut volvulus was introduced in 1936 by himself [3]. The true incidence of malrotation of the midgut is unknown because the spectrum of anatomic forms of malrotation includes minor derangements that predictably are asymptomatic and therefore undiagnosed [4]. The incidence of clinically symptomatic intestinal malrotation has been reported to occur 1 in 6000 live births [5]. Various clinical presentations, ranging from chronic abdominal pain to acute midgut volvulus with ischemic bowel injury, may result from failure of normal intestinal rotation and fixation [6]. Most patients with midgut volvulus present in the first month of life [7]. The primary presenting sign of malrotation is the sudden onset of bilious vomiting in a previously healthy, growing infant [8]. The chronic intermittent or partial midgut volvulus is less frequent than acute one and leads to lymphatic and venous obstruction with enlargement of the mesenteric lymph nodes [9]. Recurrent abdominal pain is the cardinal manifestation of chronic midgut volvulus[10]. This form, is more common in children older than 2 years of age [11,12].